BARNSLEY CHILD AND ADOLESCENT MENTAL HEALTH SERVICE (CAMHS) CHILDREN IN CARE (CiC) PATHWAY Date issued: June 2017 Author: Children in Care Pathway Lead & General Manager In consultation with Children in Care Service, Barnsley Metropolitan Borough Council www.southwestyorkshire.nhs.uk
TABLE OF CONTENTS Paragraph Page No Service Description 3 Background 3 Current context 4 Data 4 Referral Process 5 Involvement of Children/young people and birth parents 6 Access to Service 6 Current service provision 6/7 Appendices Page No 1 Children in Care Pathway 8 2 Barnsley CAMHS Information for Referrers 9-12 3 Barnsley CAMHS Referral Form 13-15 Page 2
Service Description: The Barnsley CAMHS Children in Care (CiC) Pathway delivers specialist consultation, skills and training to children in care (0-18 years) and their carers to promote emotional and psychological wellbeing and placement stability. The service offers support and training to carers and the wider professional network, assessment of children and young people s emotional health needs and where appropriate direct therapeutic with a young person and/or their carers for trauma and attachment issues. Liaison and progression to other CAMHS pathways can be made for specialist assessments or pieces of work and the service also signposts and facilitates referral to other services as appropriate to meet identified need. Background: The provision of mental health services for children in care have traditionally been viewed as highly complex and lacking structure, with children and young people in care frequently denied access as they often do not meet thresholds for diagnostic criteria, despite the high prevalence of mental health issues in this group (NICE 2015) 1. There has also been concern around timely access to appropriate therapeutic support for those young people who are in shortterm and/or unstable placements. NICE guidelines on attachment offer best practice advice on the care of children and young people with attachment difficulties including those adopted from care, in care or at high risk of going into care (on the edge of care). One of the key recommendations relates to the need to ensure all children and young people and their parents or carers get equal access to interventions for attachment difficulties regardless of their context. The evidence suggests this client group needs targeted and dedicated provision that prioritises their needs, allows flexible and timely access to services, alongside the development of clear referral pathways and effective partnership and multiagency working. Statutory guidance is clear that a specialist mental health Children in Care (previously described as looked after children ) should be provided to support children according to need. 2 The guidance also gives consideration to those on the edge of care, adopted from care and special guardianship arrangements. There are many such kinship care arrangements in Barnsley and there is a clear need for work targeting this client group. Guidance for children in care (NICE 2010) 3 reports on the need for more flexible and accessible services from CAMHS to both help improve mental health and well-being, but also prevent the escalation of challenging 1 Children sattachment: attachment in children and young people who are adopted from care, in care or at high risk of going into care, (NICE, 2015 : nice.org.uk/guidance/ng26) 2 Promoting the Health of Looked After Children( DoH and DfE, (2015) (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/413368/promoting the health and wellbeing of looked after children.pdf 3 Promoting the quality of life of looked after children and young people (2010 NICE: https://www.nice.org.uk/guidance.ph28 Page 3
behaviours and placement breakdown. The guidance has recommendations specific to CAMHS which includes early identification and prevention of physical and emotional health problems and access to specialist CAMHS services for children and young people who are in care. Guidance also recommends that professional consultancy and regular training; support and education programmes are available for social workers and carers. The Commons Select Committee report (2016) 4 recognises the significant challenges children in care face accessing mental health service and recommends they be given priority access to mental health assessments by specialist practitioners, with subsequent treatment based on clinical need. Current context: NICE guidance reports that children and young people placed out of their local authority area are less likely to receive CAMHS in their new location and there is a clear need for services to prioritise this client group. Information shared by Barnsley Local Authority in March 2017 indicates that there were 291 children and young people in the care of Barnsley local authority. Of these 93 children were placed outside of Barnsley 58 0 to 10 miles 11 10 to 20 miles 24 20 plus miles For those Barnsley young people placed out of Borough the CAMHS service in the locality in which the child is residing will assess and offer any service requested to meet their needs. Likewise Barnsley has significant numbers of out of area children and young people placed in the local area and the CAMHS service accepts referral of these children. There are a number of private beds located within Barnsley and the young people in these specialist placements have complex needs and often present for urgent assessment and crisis management due to presentations of high risk. In line with statutory guidelines these young people are seen within the Generic Emergency Care Pathway in conjunction with the CiC Pathway. The proactive management of risk via the consultation and training offered to professionals and carers is a key objective of the CiC pathway. Data: From 1 st April 2016 and 31 st January 2017 52 of cases have been reviewed in the consultation clinic of which 32 were from Barnsley and 20 were placed in 4 Mental health and wellbeing of looked after children: Government response to the Committee s Fourth Report of Session 2015-16, DH & DfE published 2016 Page 4
Barnsley from another authority and are described as out of area for the purpose of this pathway. Of these 30 cases were then offered a service within specialist CAMHS. This is 19 Barnsley and 11 out of area cases. As at December 2016 there were 310 children and young people in the care of Barnsley local authority of which 115 had been known to CAMHS at some time and of these 34 were out of area cases. Currently, the service provides a small dedicated resource for all CiC referred to CAMHS Referral Process: The Social Worker completes a referral form to CAMHS ensuring to identify the child as a Child in Care. The referral is then triaged for urgency by the Single Point of Access (SPA) team at CAMHS. If the outcome of triage is that an Emergency assessment is required the referral will be allocated to the Emergency Care Pathway who will see the child and ensure liaison with the CiC Pathway Lead. The core offer is that the CiC Pathway initially make an appointment for a consultation clinic meeting with the young person s social worker, foster carers and any other professionals working with the young person. This meeting is not typically attended by the child/ young person or the birth parents. At this meeting, the young person s psychological and emotional health needs are explored, a psychological formulation of the young person s presentation is produced. The purpose of this meeting is to enable a supportive environment for those staff and foster carers to inform a decision about the most appropriate support/intervention including who will be responsible. This plan of care may be for further consultation and support, work directly with carers (either individual or group work), or the young person can be offered further assessment and/or therapeutic work for attachment and trauma issues. Where necessary the child may require an intervention via another Specialist CAMHS pathway and the CiC will always signpost and /or facilitate referral to other services as appropriate. To facilitate a decision about who should be invited to this meeting the child s Social Worker will be asked to identify and or provide (at the point of referral) the following information: The Legal status of the child i:e : which care order they are subject to and who holds Parental Responsibility and the overriding authority for decision making. A detailed Chronology Any Previous work undertaken both in and out of area and copies of any reports commissioned by social care. Details of any prior CAMHS involvement from another CAMHS service and details of the service with dates that is held on the child s social care record (Note: NHS organisations do not have access to a Page 5
centralised health record and may need to request details from the relevant CAMH Service) Details of agencies involved and current placement details. Involvement of Children / young people and birth parents: Where a child / young person or birth parent has requested to attend the CiC consultation meeting the CiC pathway staff will consult with the child s Social Worker to enable a decision to be made on a case by case basis as to how the young person s psychological and emotional health needs are best explored. Consideration will be given as to the benefits of a CiC consultation and subsequent family meeting or an integrated CiC initial review. This will typically be based on the age and competence of the child, legal rights of the birth parents and the risks and benefits to the child of any decision to include / exclude. The CiC pathway will seek guidance from the Local Authority with regard the child and family s requests and rights to participate in part or all of the CiC offer. This guidance will also include the legal right to information such as the outcome of any decisions and plans of care agreed. On reaching a decision upon the participation of children and birth parents the CiC pathway will advise the allocated Social Worker of the dates of any planned meetings and request that they invite the agreed family members in a timely manner. Access to Service: An appointment for the initial consultation meeting should take place within 6 weeks. If there is clear evidence that a child or young person needs a face-toface assessment this is prioritised and they will be seen within 2 weeks of the request. This is compared to a commissioned 5 week wait in the generic population. See flowchart for CiC pathway (see Appendix 1). Current service provision: The service will offer an individualised package of care based on assessed need. This package will be agreed by the multiagency team under the guidance of the CiC CAMHS pathway. The CiC pathway will then arrange the delivery of the package from a variety of interventions on offer as below. 1. Advice, consultation and training to carers and the professional networks responsible for the care of children and young people to facilitate the provision of quality parenting and care in order to promote the emotional Page 6
wellbeing of children and young people in care. This includes the offer of a 12 week Fostering Lasting Attachments group (FLAG) for foster carers, Kinship carers and adoptive parents. This aims to provide carers with support for their therapeutic parenting and increase understanding of their childrens emotional and behavioural needs through an increasing understanding of attachment theory and its application to the parenting of these children. 2. On-going consultation, advice and training to social workers to assist care planning, the identification of any therapeutic needs, help with placements and transitions for children and young people in care. Consultation is also available to support placements at risk of breakdown. 3. Direct assessment of children and young people s emotional health needs and appropriate therapeutic work for trauma and attachment issues. 4. Access to specialist pathways in CAMHS as appropriate 5. Liaison with wider services and signposting to other services as appropriate, for example early intervention services such a 4:Thought the schools based mental health provision for children in secondary education. 6. Teaching and training. The Children In Care pathway contributes to training via the Local Children s Safeguarding Board. The pathway also offer bespoke training on request based on identified need. This can be delivered to professionals and carers. 7. CAMHS representation at the Multi-Agency Victims of Complex Abuse (MVCA) Panel. 8. A monthly consultation/reflective practice meeting for workers who have a role in supporting children identified at MVCA panel. This is to ensure the principles of the Empower and Protect Programme are embedded in service delivery for what are identified as Barnsley s most high risk and complex children. This may include indirect work with children and young people in care and on the edge of care. 9. Provision of consultation to Barnsley s children and young peoples residential provision. 10. Attendance at the Children with Health Needs in Care group. 11. Co opted attendance for clinical consultation at the Children s Resource Allocation Group (CRAG). Page 7
APPENDIX 1 BARNSLEY CAMHS CHILDREN IN CARE PATHWAY Contact details: Barnsley CAMHS, New Street Health Centre, Upper New Street, Barnsley, S70 1LP Tel: 01226 644829 Referral for Children & Young People in Care Received Specialist CAMHS Single Point of Access Referral form identifies Child in Care Screened for urgency (same day) Consultation Clinic appointment requested and / or routine face to face assessment within 2 weeks (unless emergency) CIC Admin / CiC pathway lead Arranges appointment for Consultation and sends invites Arranges 1-1 session with CiC pathway within 2 weeks if indicated CiC pathway lead Reviews information and requests further information / reports etc. Professional network identified confirming invitees with child s social worker Agreement reached and recorded as to child / birth family involvement, plan and liaison Consultation Clinic convened (within 6 weeks) Multi-agency / professional and carer meeting to consider child s needs from attachment/therapeutic perspective. Consultation with professional network to include foster carers, social worker, education, other health professionals, residential carers, formulate and plan from psychological perspective Urgent slots and child/ birth family follow up meetings available as needed Discharge Routine Further Consultation meetings As above and to support placements at risk of breakdowns Attachment focused work Work with carers/system 12 week Fostering Lasting Attachment Group (FLAG) Theraplay Consultation to Spring Lane 1 x monthly Discussion and liaison prior to referral can be offered if required via the CiC pathway leads or CAMHS Single Point of Access (SPA) team Tel: 01226 644829 Emergency (24 hour response) or Urgent (1 week response) Emergency / Urgent Care Pathway Duty Staff to offer response as urgent care pathway and liaise with CiC Pathway Lead to ensure continuity of care, share plan /agree meetings Assessment by duty staff Complete assessment and risk assessment including relevant outcome measures as appropriate Intensive input Assessment (to include multi-disciplinary assessment of complex difficulties) Intervention Video feedback (if possible) Individual work with child e.g. trauma focused work / CBT /EMDR Medical assessment and review when indicated Dyadic work with child/young person Regular reviews/meetings with social care Communicate outcome to CiC pathway lead, allocated social worker and GP as a minimum in writing within 72 hours Discharge MVCA PANEL Refer to other Pathway / Joint Work E.g. Complex behavioural/emotional/a SD/LD/ EMDR (AS PRIORITY GROUP) EMPOWER AND PROTECT OFFER 12 x 1 ¼ hour reflective practice sessions offered annually to support social workers working with most vulnerable young people Discharge Further Consultation Review Communicate outcome to CiC Page pathway 8 lead, allocated social worker and GP as minimum in writing
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